OLDER ADULTS WITH COVID-19, THE ILLNESS CAUSED BY THE CORONAVIRUS, HAVE SEVERAL “ATYPICAL” SYMPTOMS, COMPLICATING EFFORTS TO ENSURE THEY GET TIMELY AND APPROPRIATE TREATMENT, ACCORDING TO PHYSICIANS.

COVID-19 IS TYPICALLY SIGNALED BY THREE SYMPTOMS: A FEVER, AN INSISTENT COUGH AND SHORTNESS OF BREATH. BUT OLDER ADULTS — THE AGE GROUP MOST AT RISK OF SEVERE COMPLICATIONS OR DEATH FROM THIS CONDITION ― MAY HAVE NONE OF THESE CHARACTERISTICS.

INSTEAD, SENIORS MAY SEEM “OFF” — NOT ACTING LIKE THEMSELVES ― EARLY ON AFTER BEING INFECTED BY THE CORONAVIRUS. THEY MAY SLEEP MORE THAN USUAL OR STOP EATING. THEY MAY SEEM UNUSUALLY APATHETIC OR CONFUSED, LOSING ORIENTATION TO THEIR SURROUNDINGS. THEY MAY BECOME DIZZY AND FALL. SOMETIMES, SENIORS STOP SPEAKING OR SIMPLY COLLAPSE.

“WITH A LOT OF CONDITIONS, OLDER ADULTS DON’T PRESENT IN A TYPICAL WAY, AND WE’RE SEEING THAT WITH COVID-19 AS WELL,” SAID DR. CAMILLE VAUGHAN, SECTION CHIEF OF GERIATRICS AND GERONTOLOGY AT EMORY UNIVERSITY.

THE REASON HAS TO DO WITH HOW OLDER BODIES RESPOND TO ILLNESS AND INFECTION.

AT ADVANCED AGES, “SOMEONE’S IMMUNE RESPONSE MAY BE BLUNTED AND THEIR ABILITY TO REGULATE TEMPERATURE MAY BE ALTERED,” SAID DR. JOSEPH OUSLANDER, A PROFESSOR OF GERIATRIC MEDICINE AT FLORIDA ATLANTIC UNIVERSITY’S SCHMIDT COLLEGE OF MEDICINE.

“UNDERLYING CHRONIC ILLNESSES CAN MASK OR INTERFERE WITH SIGNS OF INFECTION,” HE SAID. “SOME OLDER PEOPLE, WHETHER FROM AGE-RELATED CHANGES OR PREVIOUS NEUROLOGIC ISSUES SUCH AS A STROKE, MAY HAVE ALTERED COUGH REFLEXES. OTHERS WITH COGNITIVE IMPAIRMENT MAY NOT BE ABLE TO COMMUNICATE THEIR SYMPTOMS.”

RECOGNIZING DANGER SIGNS IS IMPORTANT: IF EARLY SIGNS OF COVID-19 ARE MISSED, SENIORS MAY DETERIORATE BEFORE GETTING NEEDED CARE. AND PEOPLE MAY GO IN AND OUT OF THEIR HOMES WITHOUT ADEQUATE PROTECTIVE MEASURES, RISKING THE SPREAD OF INFECTION.

DR. QURATULAIN SYED, AN ATLANTA GERIATRICIAN, DESCRIBES A MAN IN HIS 80S WHOM SHE TREATED IN MID-MARCH. OVER A PERIOD OF DAYS, THIS PATIENT, WHO HAD HEART DISEASE, DIABETES AND MODERATE COGNITIVE IMPAIRMENT, STOPPED WALKING AND BECAME INCONTINENT AND PROFOUNDLY LETHARGIC. BUT HE DIDN’T HAVE A FEVER OR A COUGH. HIS ONLY RESPIRATORY SYMPTOM: SNEEZING OFF AND ON.

THE MAN’S ELDERLY SPOUSE CALLED 911 TWICE. BOTH TIMES, PARAMEDICS CHECKED HIS VITAL SIGNS AND DECLARED HE WAS OK. AFTER ANOTHER WORRIED CALL FROM THE OVERWHELMED SPOUSE, SYED INSISTED THE PATIENT BE TAKEN TO THE HOSPITAL, WHERE HE TESTED POSITIVE FOR COVID-19.

“I WAS QUITE CONCERNED ABOUT THE PARAMEDICS AND HEALTH AIDES WHO’D BEEN IN THE HOUSE AND WHO HADN’T USED PPE [PERSONAL PROTECTIVE EQUIPMENT],” SYED SAID.

DR. SAM TORBATI, MEDICAL DIRECTOR OF THE RUTH AND HARRY ROMAN EMERGENCY DEPARTMENT AT CEDARS-SINAI MEDICAL CENTER, DESCRIBES TREATING SENIORS WHO INITIALLY APPEAR TO BE TRAUMA PATIENTS BUT ARE FOUND TO HAVE COVID-19.

“THEY GET WEAK AND DEHYDRATED,” HE SAID, “AND WHEN THEY STAND TO WALK, THEY COLLAPSE AND INJURE THEMSELVES BADLY.”

TORBATI HAS SEEN OLDER ADULTS WHO ARE PROFOUNDLY DISORIENTED AND UNABLE TO SPEAK AND WHO APPEAR AT FIRST TO HAVE SUFFERED STROKES.

“WHEN WE TEST THEM, WE DISCOVER THAT WHAT’S PRODUCING THESE CHANGES IS A CENTRAL NERVOUS SYSTEM EFFECT OF CORONAVIRUS,” HE SAID.

​

DR. LAURA PERRY, AN ASSISTANT PROFESSOR OF MEDICINE AT THE UNIVERSITY OF CALIFORNIA-SAN FRANCISCO, SAW A PATIENT LIKE THIS SEVERAL WEEKS AGO. THE WOMAN, IN HER 80S, HAD WHAT SEEMED TO BE A COLD BEFORE BECOMING VERY CONFUSED. IN THE HOSPITAL, SHE COULDN’T IDENTIFY WHERE SHE WAS OR STAY AWAKE DURING AN EXAMINATION. PERRY DIAGNOSED HYPOACTIVE DELIRIUM, AN ALTERED MENTAL STATE IN WHICH PEOPLE BECOME INACTIVE AND DROWSY. THE PATIENT TESTED POSITIVE FOR CORONAVIRUS AND IS STILL IN THE ICU.

DR. ANTHONY PERRY, AN ASSOCIATE PROFESSOR OF GERIATRIC MEDICINE AT RUSH UNIVERSITY MEDICAL CENTER IN CHICAGO, TELLS OF AN 81-YEAR-OLD WOMAN WITH NAUSEA, VOMITING AND DIARRHEA WHO TESTED POSITIVE FOR COVID-19 IN THE EMERGENCY ROOM. AFTER RECEIVING IV FLUIDS, OXYGEN AND MEDICATION FOR HER INTESTINAL UPSET, SHE RETURNED HOME AFTER TWO DAYS AND IS DOING WELL.

ANOTHER 80-YEAR-OLD RUSH PATIENT WITH SIMILAR SYMPTOMS — NAUSEA AND VOMITING, BUT NO COUGH, FEVER OR SHORTNESS OF BREATH ― IS IN INTENSIVE CARE AFTER GETTING A POSITIVE COVID-19 TEST AND DUE TO BE PUT ON A VENTILATOR. THE DIFFERENCE? THIS PATIENT IS FRAIL WITH “A LOT OF CARDIOVASCULAR DISEASE,” PERRY SAID. OTHER THAN THAT, IT’S NOT YET CLEAR WHY SOME OLDER PATIENTS DO WELL WHILE OTHERS DO NOT.

SO FAR, REPORTS OF CASES LIKE THESE HAVE BEEN ANECDOTAL. BUT A FEW PHYSICIANS ARE TRYING TO GATHER MORE SYSTEMATIC INFORMATION.

IN SWITZERLAND, DR, SYLVAIN NGUYEN, A GERIATRICIAN AT THE UNIVERSITY OF LAUSANNE HOSPITAL CENTER, PUT TOGETHER A LIST OF TYPICAL AND ATYPICAL SYMPTOMS IN OLDER COVID-19 PATIENTS FOR A PAPER TO BE PUBLISHED IN THE REVUE MÉDICALE SUISSE. INCLUDED ON THE ATYPICAL LIST ARE CHANGES IN A PATIENT’S USUAL STATUS, DELIRIUM, FALLS, FATIGUE, LETHARGY, LOW BLOOD PRESSURE, PAINFUL SWALLOWING, FAINTING, DIARRHEA, NAUSEA, VOMITING, ABDOMINAL PAIN AND THE LOSS OF SMELL AND TASTE.

DATA COMES FROM HOSPITALS AND NURSING HOMES IN SWITZERLAND, ITALY AND FRANCE, NGUYEN SAID IN AN EMAIL.

ON THE FRONT LINES, PHYSICIANS NEED TO MAKE SURE THEY CAREFULLY ASSESS AN OLDER PATIENT’S SYMPTOMS.

“WHILE WE HAVE TO HAVE A HIGH SUSPICION OF COVID-19 BECAUSE IT’S SO DANGEROUS IN THE OLDER POPULATION, THERE ARE MANY OTHER THINGS TO CONSIDER,” SAID DR. KATHLEEN UNROE, A GERIATRICIAN AT INDIANA UNIVERSITY’S SCHOOL OF MEDICINE.

SENIORS MAY ALSO DO POORLY BECAUSE THEIR ROUTINES HAVE CHANGED. IN NURSING HOMES AND MOST ASSISTED LIVING CENTERS, ACTIVITIES HAVE STOPPED AND “RESIDENTS ARE GOING TO GET WEAKER AND MORE DECONDITIONED BECAUSE THEY’RE NOT WALKING TO AND FROM THE DINING HALL,” SHE SAID.

AT HOME, ISOLATED SENIORS MAY NOT BE GETTING AS MUCH HELP WITH MEDICATION MANAGEMENT OR OTHER ESSENTIAL NEEDS FROM FAMILY MEMBERS WHO ARE KEEPING THEIR DISTANCE, OTHER EXPERTS SUGGESTED. OR THEY MAY HAVE BECOME APATHETIC OR DEPRESSED.

“I’D WANT TO KNOW ‘WHAT’S THE POTENTIAL THIS PERSON HAS HAD AN EXPOSURE [TO THE CORONAVIRUS], ESPECIALLY IN THE LAST TWO WEEKS?’” SAID VAUGHAN OF EMORY. “DO THEY HAVE HOME HEALTH PERSONNEL COMING IN? HAVE THEY GOTTEN TOGETHER WITH OTHER FAMILY MEMBERS? ARE CHRONIC CONDITIONS BEING CONTROLLED? IS THERE ANOTHER DIAGNOSIS THAT SEEMS MORE LIKELY?”

“SOMEONE MAY BE JUST HAVING A BAD DAY. BUT IF THEY’RE NOT THEMSELVES FOR A COUPLE OF DAYS, ABSOLUTELY REACH OUT TO A PRIMARY CARE DOCTOR OR A LOCAL HEALTH SYSTEM HOTLINE TO SEE IF THEY MEET THE THRESHOLD FOR [CORONAVIRUS] TESTING,” VAUGHAN ADVISED. “BE PERSISTENT. IF YOU GET A ‘NO’ THE FIRST TIME AND THINGS AREN’T IMPROVING, CALL BACK AND ASK AGAIN.”

THIS STORY ALSO RAN ON CNN. THIS STORY CAN BE REPUBLISHED FOR FREE (DETAILS). To republish this story learn by by visiting the following link: https://khn.org/syndication/

By Joshua Gordon,M.D., P.hd NIMH Directorand The National Institute of Mental Health Information Resource Center on March 16, 2020

These are confusing, stressful times for all of us. As the coronavirus pandemic affects numerous facets of our society, it also impacts each person in different ways. The disruptions to daily life are already being felt by many, my family included—my son has been sent home from college, my place of worship has closed, and the comforting social gatherings that usually fill my weekends are off-limits. We are all feeling uncertain about what could happen in the coming weeks, as we hope to slow the spread of this pandemic. Feelings of anxiety and uncertainty are completely normal during times like this.

Now imagine you are facing this uncertainty and have a mental illness. How much more challenging must it be to navigate this uncertainty? While we all are concerned about the future, for those with anxiety disorders, worry may be all-consuming. For those with schizophrenia, the concern that people are infectious may contribute to paranoia. And for those with depression, lack of social engagement and disruption in routines could increase symptoms.

If you need support coping with the events of the last few weeks, there is advice and help available. The Centers for Disease Control and Prevention (CDC) has a webpage with information on dealing with fear, anxiety, and stress brought on by the coronavirus pandemic. A section of this CDC page is specifically geared toward those of us with children, as they can be particularly sensitive to uncertainty. For additional shareable resources for those with children, see this NPR story, which features an interview with National Institute of Mental Health expert Dr. Krystal Lewis. Link:https://www.npr.org/sections/goatsandsoda/2020/02/28/809580453/just-for-...

For those with mental illnesses, be sure to continue your treatment regimens. Consider developing a plan for telehealth sessions with your provider if you (or your provider) are quarantined or must avoid exposures to the public for any reason. And, reach out to friends and family for support, virtually if necessary.

This last piece of advice is really important for all of us. It is important to realize that social distancing does not have to mean social isolation, especially with modern technologies available to many of us. Connecting with our friends and loved ones, whether by high tech means or through simple phone calls, can help us maintain ties during stressful days ahead and will give us strength to weather this difficult passage.

By Seema Verma, Administrator of the Centers for Medicare and Medicaid Services

Since older Americans are particularly vulnerable to coronavirus (COVID-19), I wanted to remind Medicare beneficiaries to be vigilant and take precautions to avoid falling victim to healthcare fraud during this pandemic.

We’re warning Medicare beneficiaries that scammers may try to use this pandemic to steal their Medicare number, banking information, or other personal data.

Unfortunately, scammers take advantage of the most vulnerable during times of uncertainty and change. You must protect yourself by making sure you only give your Medicare number to your doctor, pharmacist, hospital, health insurer, or other trusted healthcare provider.

If someone calls you on the phone, saying they’re from Medicare, and asks for your Medicare number or other personal information – just hang up.

Our representatives will never:

Call beneficiaries to ask for or to “verify” Medicare numbers.

Call to sell you anything.

Promise you things if you give them a Medicare number.

Visit you at your home.

Call you to enroll you in a Medicare program over the phone, unless you called usfirst. Medicare’s toll-free customer service center at 1-800-MEDICARE (1-800-633-4227)

We removed Social Security numbers from all Medicare cards last year to reduce fraud and protect our beneficiaries from identity theft. Even with this change, you should guard your Medicare card like you would a credit card. Be sure to check your Medicare claim summaries for errors and questionable bills.

Please help spread the word by sharing this message with family and friends. Your health and safety is important to us. So, please continue to follow President Trump’s public health guidelines by staying home. These simple actions could save more than 1 million American lives in the weeks and months to come.

For more information on Medicare and telehealth, check out Administrator Verma’s previous guest blog. To learn about Social Security services during the COVID-19 pandemic, visit our Coronavirus Disease (COVID-19) page.

Effective March 17, 2020, Social Security Offices Will Only Offer Phone Service
** Online Services Remain Available **

Print Version

All local Social Security offices will be closed to the public for in-person service starting Tuesday, March 17, 2020. This decision protects the population we serve—older Americans and people with underlying medical conditions—and our employees during the Coronavirus (COVID-19) pandemic. However, we are still able to provide critical services.

Our secure and convenient online services remain available at www.socialsecurity.gov. Local offices will also continue to provide critical services over the phone. We are working closely with the Centers for Disease Control and Prevention (CDC), state and local governments, and other experts to monitor COVID-19 and will let you know as soon as we can resume in-person service.

If you need help from Social Security:

First, please use our secure and convenient online services available at www.socialsecurity.gov/onlineservices. You can apply for retirement, disability, and Medicare benefits online, check the status of an application or appeal, request a replacement Social Security card (in most areas), print a benefit verification letter, and much more – from anywhere and from any of your devices. We also have a wealth of information to answer most of your Social Security questions online, without having to speak with a Social Security representative in person or by phone. Please visit our online Frequently Asked Questions at www.socialsecurity.gov/ask.

If you cannot conduct your Social Security business online, please check our online field office locator for specific information about how to directly contact your local office. Your local office still will be able to provide critical services to help you apply for benefits, answer your questions, and provide other services over the phone.

If you already have an in-office appointment scheduled, we will call you to handle your appointment over the phone instead. If you have a hearing scheduled, we will call you to discuss alternatives for continuing with your hearing, including offering a telephonic hearing. Our call may come from a PRIVATE number and not from a U.S. Government phone. Please remember that our employees will not threaten you or ask for any form of payment.

If you cannot complete your Social Security business online, please call our National 800 Number at 1-800-772-1213 (TTY 1-800-325-0778). Our National 800 Number has many automated service options you can use without waiting to speak with a telephone representative. A list of automated telephone services is available online at www.socialsecurity.gov/agency/contact/phone.html.

To get more Social Security news, follow the Press Office on Twitter @SSAPress.

Social Security Benefits Will be Paid On Time and Other Updates Related to the COVID-19 Pandemic

Andrew Saul, Commissioner of Social Security, reminds the public that Social Security and Supplemental Security Income (SSI) benefit payments will continue to be paid on time during the COVID-19 pandemic. The agency also reminds everyone to be aware of scammers who try to take advantage of the pandemic to trick people into providing personal information or payment via retail gift cards, wire transfers, internet currency, or by mailing cash, to maintain Social Security benefit payments or receive economic impact payments from the Department of the Treasury.

“Social Security will pay monthly benefits on time and these payments will not be affected by the COVID-19 pandemic,” Commissioner Saul said. “I want our beneficiaries to be aware that scammers may try to trick you into thinking the pandemic is stopping or somehow changing your Social Security payments, but that is not true. Don’t be fooled.”

The Department of the Treasury will soon provide information about economic impact payments under the recently enacted law, the Coronavirus Aid, Relief, and Economic Security Act, or CARES Act. Treasury, not Social Security, will be making direct payments to eligible people. Please do not call Social Security about these payments as the agency does not have information to share.

The agency continues to direct the public to its online self-service options whenever possible. Local offices are closed to the public but are available by phone. People can find their local field office phone number by accessing the Field Office Locator.

To allow available agents to provide better phone coverage, the agency is temporarily changing the National 800 Number hours starting on Tuesday, March 31, 2020. The hours will change from 7:00 a.m. to 7:00 p.m. local time to 8:00 a.m. to 5:30 p.m. local time. The agency is experiencing longer than normal wait times on the 800 Number and asks the public to remain patient, use its online services at www.socialsecurity.gov, or call their local office.

This content is provided by the National Institute on Aging (NIA), part of the National Institutes of Health. NIA

Have you ever felt dizzy, lightheaded, or as if the room were spinning around you? These can be troublesome sensations. If the feeling happens often, it could be a sign of a balance problem.

Balance problems are among the most common reasons that older adults seek help from a doctor. They are often caused by disturbances of the inner ear. Vertigo, the feeling that you or the things around you are spinning, is a common symptom.

Having good balance means being able to control and maintain your body's position, whether you are moving or remaining still. Good balance helps you walk without staggering, get up from a chair without falling, climb stairs without tripping, and bend over without falling. Good balance is important to help you get around, stay independent, and carry out daily activities.

Balance disorders are one reason older people fall. Learn more about falls and falls prevention from NIA. Visit the website of the National Institute on Deafness and Other Communication Disorders for information on specific balance disorders.

Causes of Balance Problems

People are more likely to have problems with balance as they get older. But age is not the only reason these problems occur. In some cases, you can help reduce your risk for certain balance problems.

Some balance disorders are caused by problems in the inner ear. The part of the inner ear that is responsible for balance is the vestibular system, also known as the labyrinth. A condition called labyrinthitis occurs when the labyrinth becomes infected or swollen. It is typically accompanied by vertigo and imbalance. Upper respiratory infections, other viral infections, and, less commonly, bacterial infections can also lead to labyrinthitis.

Some diseases of the circulatory system, such as stroke, can cause dizziness and other balance problems. Low blood pressure can also cause dizziness. Head injury and many medicines may also lead to balance problems.

Check with your doctor if you notice a problem while taking a medication. Ask if other medications can be used instead. If not, ask if the dosage can be safely reduced. Sometimes it cannot. However, your doctor will help you get the medication you need while trying to reduce unwanted side effects.

Symptoms of Balance Disorders

If you have a balance disorder, you may stagger when you try to walk, or teeter or fall when you try to stand up. You might experience other symptoms such as:

Dizziness or vertigo (a spinning sensation)

Falling or feeling as if you are going to fall

Lightheadedness, faintness, or a floating sensation

Blurred vision

Confusion or disorientation

Other symptoms might include nausea and vomiting; diarrhea; changes in heart rate and blood pressure; and fear, anxiety, or panic. Symptoms may come and go over short time periods or last for a long time, and can lead to fatigue and depression.

Do I Have a Balance Problem? Questions to Ask Yourself

You can help identify a balance problem by asking yourself some key questions. If you answer "yes" to any of these questions, discuss the symptom with your doctor.

Do I feel unsteady?

Do I feel as if the room is spinning around me, even only for brief periods of time?

Do I feel as if I'm moving when I know I'm standing or sitting still?

Do I lose my balance and fall?

Do I feel as if I'm falling?

Do I feel lightheaded, or as if I might faint?

Does my vision become blurred?

Do I ever feel disoriented, losing my sense of time, place, or identity?

If you think that you have a balance disorder, schedule an appointment with your doctor. Your doctor may refer you to an otolaryngologist, a doctor with special training in problems of the ear, nose, throat, head, and neck.

Balance disorders can be signs of other health problems, such as an ear infection, stroke, or multiple sclerosis. In some cases, you can help treat a balance disorder by seeking medical treatment for the illness that is causing the disorder.

Some exercises help make up for a balance disorder by moving the head and body in certain ways. The exercises are developed especially for a patient by a professional (often a physical therapist) who understands the balance system and its relationship with other systems in the body.

Balance problems due to high blood pressure can be managed by eating less salt (sodium), maintaining a healthy weight, and exercising. Balance problems due to low blood pressure may be managed by drinking plenty of fluids, such as water, avoiding alcohol, and being cautious regarding your body's posture and movement, such as standing up slowly and avoiding crossing your legs when you’re seated.

Coping with a Balance Disorder

Some people with a balance disorder may not be able to fully relieve their dizziness and will need to find ways to cope with it. A vestibular rehabilitation therapist can help you develop an individualized treatment plan.

If you have trouble with your balance, talk to your doctor about whether it’s safe to drive, and about ways to lower your risk of falling during daily activities, such as walking up or down stairs, using the bathroom, or exercising. To reduce your risk of injury from dizziness, avoid walking in the dark. You should also wear low-heeled shoes or walking shoes outdoors. If necessary, use a cane or walker, and modify conditions at your home and workplace, such as by adding handrails.

This content is provided by the National Institute on Aging (NIA), part of the National Institutes of Health. NIA scientists and other experts review this content to ensure that it is accurate, authoritative, and up to date.

My Social Securityis an online portal offered by the Social Security Administration that provides easy access to your Social Security information. The following link will connect you to My Social Security: https://www.ssa.gov/myaccount/

if you receive benefits or have Medicare, you can use your my Social Security online account to:

For more information about the Social Security Administration visit www.socialsecurity.gov. You can also use the Link below to find the Social Security Administration, SSA Office near you.The SSA Can help you with questions or issues about your retirement benefits and other federal programs such as SSI. You can also call your local Social Security office to schedule an appointment.

If you have limited income and resources, you may qualify for Medicare’s Extra Help Programmight be able to get help paying your Medicare Prescription Drug Plan’s monthly premiums, yearly deductibles, and prescription copayments. Drug costs in 2019 for most people who qualify for Extra Help will be no more than $3.40 for each generic drug and $8.50 for each brand-name drug.

Even if you’re not sure you’d qualify, it’s worth filling out a free application. Many people with Medicare may be eligible for Extra Help but don’t know it. You or a family member could be one of them.

Senior Help Desk helthcare blog credited to The National Institute on Aging, part of NIH

Article topics:

What Is Diabetes?

Types of Diabetes

What Is Prediabetes?

Symptoms of Type 2 Diabetes

Tests for Diabetes

Managing Type 2 Diabetes

Help with Diabetes Costs

Diabetes is a serious disease, and it affects many older adults. People get diabetes when their blood glucose, also called blood sugar, is too high. The good news is that you can take steps to delay or prevent type 2 diabetes, which is the most common form of the disease to develop in older adults. If you already have diabetes, there are steps you can take to manage the condition and prevent diabetes-related health problems.

What Is Diabetes?

Our bodies turn a lot of the food we eat into sugar, called glucose, which gives us energy. To use glucose as energy, our body needs insulin, a hormone that helps glucose get into our cells. If you have diabetes, your body may not make enough insulin, may not use insulin in the right way, or both. That can cause too much glucose to stay in the blood, which can cause health problems over time. Your family doctor may refer you to a doctor who specializes in taking care of people with diabetes, called an endocrinologist. Often, your family doctor will work directly with you to manage your diabetes.

Types of Diabetes

There are two main kinds of diabetes.

In Type 1 diabetes, the body does not make insulin. Although older adults can develop this type of diabetes, it begins most often in children and young adults, who then have diabetes for life.

In Type 2 diabetes, the body does not make or use insulin well. It is the most common kind of diabetes. It occurs most often in middle-aged and older adults, but it can also affect children. Your chance of getting type 2 diabetes is higher if you are overweight, inactive, or have a family history of diabetes. Women with a history of gestational diabetes (a type of diabetes that develops during pregnancy) also have a greater chance of developing type 2 diabetes later in life.

Diabetes can affect many parts of your body. It’s important to manage diabetes because, over time, it can cause serious health problems like heart disease, stroke, kidney disease, eye problems, and nerve damagethat may lead to amputation. Also, people with type 2 diabetes may be at greater risk for cancer and Alzheimer’s disease.

What Is Prediabetes?

Millions of older Americans have “prediabetes.” This means their glucose levels are higher than normal but not high enough to be called diabetes. People with prediabetes have a greater chance of developing type 2 diabetes and having a heart attack or stroke.

If you have prediabetes, there are things you can do to prevent or delay getting type 2 diabetes. Losing weight may help. Healthy eating and being physically active can make a big difference. Work with your doctor to set up a plan to help you make healthier food choices and get regular exercise. Get help with quitting smoking (if you smoke), because smokers are more likely than nonsmokers to develop type 2 diabetes. Make sure to ask how often you should have your glucose levels checked. Your doctor may also talk with you about taking medication to delay or prevent type 2 diabetes.

Symptoms of Type 2 Diabetes

Symptoms of type 2 diabetes may include feeling tired, increased hunger or thirst, losing weight without trying, urinating often, or having trouble with blurred vision. You may also get skin infections or heal slowly from cuts and bruises. Some people with type 2 diabetes may not realize they have it because symptoms often develop slowly and go unnoticed. Sometimes older adults dismiss these symptoms as “getting old,” but they can be signs of a serious problem. Talk with your doctor if you have any of these symptoms.

Tests for Diabetes

Doctors use several blood tests to help diagnose diabetes:

Random plasma glucose test—given at any time during the day

A1C test—given at any time during the day; shows your average glucose level for the past 3 months

Fasting plasma glucose test—taken after you have gone without food for at least 8 hours

Oral glucose tolerance test—taken after fasting overnight and then again 2 hours after having a sugary drink (This is not regularly given for type 2 diabetes).

Your doctor may want you to be tested for diabetes twice before making a diagnosis.

Managing Type 2 Diabetes

Many people with type 2 diabetes can manage their blood glucose levels with diet and exercise alone. Others may need diabetes pills or insulin injections, along with medicines to manage other conditions like high blood pressure and high cholesterol. Over time, a person with diabetes may need both lifestyle changes and medication.

Share this infographic and help spread the word about the everyday benefits of exercise and physical activity.

Once you’ve been told you have diabetes, a healthcare team will work with you to create a diabetes management plan. Your plan will be based on your lifestyle, preferences, health goals, and other health conditions you have.

As part of your plan, your doctor may prescribe one or more medications. Other healthcare professionals may also be involved. For example, a diabetes educator may help you understand diabetes and provide support as you make lifestyle changes to manage your diabetes. A dietitian may help with meal planning. An exercise coach may help you become more physically active.

Diabetes and Brain Health

If you have diabetes, your doctor may screen you for depression or cognitive impairment. Older adults with diabetes are at higher risk for these conditions, compared with others their age who do not have diabetes. Having depression or cognitive impairment can make diabetes self-care challenging.

Your diabetes management plan will cover how to:

Track your glucose levels. Very high glucose levels (called hyperglycemia) or very low glucose levels (called hypoglycemia) can be risky to your health. Your plan will show how often you should check your glucose and how often to get the A1C test. If you are managing your diabetes without taking insulin, you may not need to check your glucose as often.

Make healthy food choices. The food you eat affects glucose levels, so it’s important to learn what’s best for you to eat, how much, and when. If you are overweight, work with your healthcare team to come up with a plan to lose weight.

Be active. Walking and other forms of daily exercise can help improve glucose levels in older people with diabetes. Set a goal to be more active most days of the week, and create a plan for being physically active that fits into your life and that you can follow. Your healthcare team can help. For exercise information and examples, visit the NIA’s Go4Life® website or call 1-800-222-2225 (toll-free).

Take your medicines. You should take medicine as prescribed even when you feel good. Tell your doctor if you have any side effects or cannot afford your medicines. Also, let your doctor know if you have trouble taking your medicine or keeping track of your medication schedule.

Here are some ways to stay healthy with diabetes:

Manage your blood pressure. Get your blood pressure checked often.

Manage your cholesterol. At least once a year, get a blood test to check your cholesterol and triglyceride levels. High levels may increase your risk for heart problems.

Check your kidneys yearly. Diabetes can affect your kidneys. Urine and blood tests will show if your kidneys are okay.

Get flu shots every year and the pneumonia vaccine. A yearly flu shot will help keep you healthy. If you’re over 65, make sure you have had the pneumonia vaccine. If you were younger than 65 when you had the pneumonia vaccine, you may need another one. Ask your doctor.

Care for your teeth and gums. Brush your teeth and floss daily. Have your teeth and gums checked twice a year by a dentist to avoid serious problems.

Protect your skin. Keep your skin clean and use skin softeners for dryness. Take care of minor cuts and bruises to prevent infections.

Look at your feet. Take time to look at your feet every day for any red patches. Ask someone else to check your feet if you can’t. If you have sores, blisters, breaks in the skin, infections, or build-up of calluses, see a foot doctor, called a podiatrist.

Keep up with cancer screenings. Ask your doctor which screenings to get based on your age, gender, and other risk factors.

Talk with your doctor about your concerns. If you think you might need help with your management plan, are depressed, are worried about your memory, or have any other concerns, talk with your doctor. There may be ways to help.

At least once a year, your healthcare team will assess how well you are managing your diabetes. Your management plan might need changes, or you may need more information and support. A change in health, such as a new diagnosis or complication, or a change in care, such as going home from the hospital, may also lead to changes to your diabetes management plan.

Be Prepared

Make sure you always have at least 3 days’ worth of supplies on hand for testing and treating your diabetes in case of an emergency.

Help with Diabetes Costs

Medicare may pay to help you learn how to care for your diabetes. It may also help pay for diabetes tests, supplies, flu and pneumonia shots, special shoes, foot exams, eye tests, and meal planning. For more information about what Medicare covers, call 1-800-633-4227 (1-800-MEDICARE) or visit the Medicare website.

For the first time, the federal government is shining a spotlight on the quality of rehabilitation care at nursing homes — services used by nearly 2 million older adults each year.

Medicare’s Nursing Home Compare website now includes a “star rating” (a composite measure of quality) for rehab services — skilled nursing care and physical, occupational or speech therapy for people recovering from a hospitalization. The site also breaks out 13 measures of the quality of rehab care, offering a more robust view of facilities’ performance.

Independent experts and industry representatives welcomed the changes, saying they could help seniors make better decisions about where to seek care after a hospital stay. This matters because high-quality care can help older adults regain the ability to live independently, while low-quality care can compromise seniors’ recovery.

“It’s a very positive move,” said David Grabowski, a professor of health care policy at Harvard Medical School. He noted that previous ratings haven’t distinguished between two groups in nursing homes with different characteristics and needs — temporary residents getting short-term rehabilitation and permanent residents too ill or frail to live independently.

Temporary residents are trying to regain the ability to care for themselves and return home as soon as possible, he noted. By contrast, permanent residents aren’t expecting improvements: Their goal is to maintain the best quality of life.

Three separate ratings for the quality of residents’ care now appear on the Nursing Home Compare website: one for overall quality (a composite measure); another one for “short-stay” patients (people who reside in facilities for 100 days or less, getting skilled nursing services and physical, occupational or speech therapy) and a third for “long-stay” patients (people who reside in facilities for more than 100 days).

Ratings for short-stay patients — available for 13,799 nursing homes — vary considerably, according to a Kaiser Health News analysis of data published by the government in late April. Nationally, 30% of nursing homes with a rating received five stars, the highest possible. Another 21% got a four-star rating, signifying above-average care. Twenty percent got three stars, an average performance. Seventeen percent got two stars, a worse-than-average score. And 13% got one star, a bottom-of-the-barrel score. (Altogether, 1,764 nursing homes did not receive ratings for short-stay patients.)

Here’s information about how to find and use the new Nursing Home Compare data, as well as insights from Kaiser Health News’ analysis:

Finding data about rehabilitation. Enter your geographic location on Nursing Home Compare’s home page, and a list of facilities will come up. You can select three at a time to review. Once you’ve done so, hit the “compare now” button at the top of the list. (To see more facilities, you’ll need to repeat the process.)

A new page will appear with several tabs. Click on the one marked “quality of resident care.” The three overall star ratings described above will appear for the facilities you’ve selected.

Below this information, two options are listed on the left side: “short-stay residents” and “long-stay residents.” Click on “short-stay residents.” Now you’ll see 13 measures with actual numbers included (most but not all of the time), as well as state and national averages.

Understanding the star rating. Six measures are used to calculate star ratings for the quality of rehab care for short-stay patients. Two of them concern emergency room visits and rehospitalizations, potential indicators of problematic care. Another two examine how well pain was controlled and bedsores were managed. One measure looks at how many patients became better able to move around on their own, an important element of recovery. Yet another examines the rate at which antipsychotic medications were newly prescribed. (These drugs can have significant side effects and are not recommended for older adults with dementia.)

One measure of great interest to seniors is the percentage of residents who return successfully home after a short nursing home stay. But actual numbers aren’t available on the Nursing Home Compare website this time around: Instead, facilities are listed as below average, average or above average. The national average, reported in April, was 48.6%, indicating room for improvement.

Tracking variations in performance. Some facilities outperform others by large margins on measures of quality of care for short-stay residents. And some facilities have high scores in some areas, but not in others.

For instance, the nursing home at Westminster Village, a high-end continuing care retirement community in Scottsdale, Ariz., had the highest score for rehospitalizations — 39.9% — out of 68 facilities in and around Phoenix. (By contrast, the lowest score in the Phoenix area was 15.4% and the state average was 23.5%.) It also had the highest rate of helping residents improve their ability to move around on their own — 88.6%. (The lowest score was 37.6% and the state average was 63.6%.)

In an email, Lesley Midkiff, marketing director at Westminster Village, said that the facility’s staff is vigilant about sending residents back to the hospital if health issues arise. At the same time, she said, staffers “push the residents just enough to regain independence and recover quickly from their short term stays.” Both priorities have the “residents’ best interest” in mind, she said.

If a facility has an average or low quality score, Dr. David Gifford, a senior vice president at the American Health Care Association, a nursing home industry group, recommended that people look closely at various measures and try to figure out where the institution fell short. Call the facility and ask them to explain, he said. Also, review Nursing Home Compare’s information about staffing and health inspections, Gifford suggested, and visit the facility if possible.

Variations within nursing homes. The newly published Nursing Home Compare data also shows that institutions aren’t always equally adept at caring for short-stay and long-stay residents.

Disparities in facilities’ ratings for short- and long-stay patients are common. Of 13,351 nursing homes that received both ratings, 32% received the same star ratings for the quality of care received by short-stay and long-stay residents. Another 32% of facilities received higher star ratings for short-stay residents, while 36% got higher ratings for long-stay residents. About one-third of the time, these rating categories were one star apart, but in another third of cases, they varied by two or more stars — a significant discrepancy. (This analysis does not include 2,212 nursing homes for which data was missing.)

In Phoenix, Desert Terrace Healthcare Center, which bills itself on its website as the city’s “premier location for short-term rehabilitation and long-term care,” is one such facility. Its quality-of-care rating for short-term residents was two stars, while its rating for long-term residents was five stars. Notably, hospital admissions and ER visits for short-stay patients were higher than the state average, while the portion of short-stay residents whose mobility improved was lower than average.

In an email, Jeremy Bowen, the facility’s administrator, wrote that the facility had a good record of managing pain and bedsores and limiting antipsychotic prescriptions for short-stay patients. Factors such as hospital readmissions depend on community resources and patients’ understanding of their health needs, which are difficult to control, he noted.

Sierra Winds, part of a continuing care community in Peoria, Ariz., has a similar split in quality ratings (two stars for short-stay residents, five stars for long-stay residents). On four of six measures used to calculate star ratings for short-stay residents, it performed worse than the state average.

“Sierra Winds remains committed to providing the highest quality care and services to its residents,” wrote Shannon Brown, the facility’s executive director, in an email. “We are proud of our 4-star rating with CMS [the Centers for Medicare & Medicaid Services].”

That’s the facility’s overall rating (this includes data about staffing and health inspections). But it doesn’t address the split in scores for short-stay and long-stay patients, which raises a red flag and should certainly cause seniors and their families to ask follow-up questions.

“If I’m a patient looking for a place for a short-term rehab stay, I really want to know how patients who look like me did,” said Dr. Rachel Werner, executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania and a quality-measurement expert.

KHN senior correspondent Jordan Rau contributed to this report.

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips. Link: https://khn.org/columnists/

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